18 WILLOW AVE - BUILDING INSPECTION �p - JLJ - 1 -15 21 3 `7 4> 55
The Commonwealth of Massachusetts RECEIVE
W
Board of Building Regulations and Standar4NSPECTIOWAL S RVIEEISt'OF
Massachusetts State Building Code, 780 CMR SALEM
Rµy 6S t4ar 2011
Building Permit Application To Construct, Repair, Renovate n{1pQ6Jli� ``FF ��L`
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date plied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pproperty Address: 1.2 Assessors Map&Parcel Numbers
� B IAfr I(0 7��`
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:r
Pam,
v� roa�S 4ay,Ai<v/II�t Y �0�0 7
ame(i��Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Ef Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:
B 'ef Description of Proposed Work': I n (CLG2vhQ/l Slr a<<
00
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1. Building $ 4 I D 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: -
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ I o 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.11 Construction Supervisor License(CSL) DS-1-73 3 w'/5—
(—'t-r✓FS -,6r Zy License Number Expiration Date
Name of CSL Holder
No/ rl may. � List CSL Type(see below)
No.and Street n Type Description
So,(e rn I".A- 01� / 7 V U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
q SF Solid Fuel Burning Appliances
9 g-Tf(-0` ;24 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
—Ae, —ce✓✓i ULS /nC • I D [ Irat q �6/
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
_l/S /0
No tree[ „n oi4,7U Email address
City/Town, State,ZIP hone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ...........V No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize (2,yj vk S Z o✓2
to act on my behalf,in all matters relative to work authorized by this building pern tt application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contai d in is application is true and accurate to the best of my knowledge and understanding.
nn Owner's or Authoril ed Agcnt's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
wmv.mass.gov/oca Information on the Construction Supervisor License can be found at www.nmss.aov/A2s
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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M NORTH STREET, SALEM,NIA 007(1
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:B'B'Al A. s5 lg will�'v kre— Contractor Registration No. 101isag
Federal EiW; 04-3090182 AM C9) Constwction Supervisor Nor Cgp87733 -
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A&A S 115 NOW04 rSTREET,S 1LE',N1A 01970
Tolophone:(08)741.0424 Fa-,;(978)741.2D(Z
5bF3AA all , (&LUII�OWAVq- Contractor Registration No.101608
. . - Federal EIN;04.300162 SkY�k*14 c l9 7Za CbnsCNction Super isorNo,C5057733
ENTRY'.DOOR 5PE r.F.1CXTi0N SHEET
av w'1 Name Date of goMmet.
.suywls StreotAgd(ess,GRy,2LIwanp MU cede
Daytime TelepnOno Number. Evgdinp'reldphons Nemlw 'Nablle Tdlephans Nwrbei £Mad Addrere:
TFu tlwyertaj I4roQ shave nerebyjofntly and severally cams to oumiraan dw gouda endror demcao fglsd bs6xL m;acnocdance vatlt IN picas and termN:dGxrlbed m feis S0961101bn ehk'et ddd Bte fronLMd 1dd reveraepf the=cff enota;OUSiDM REMDDEL1Iad AND IMPR0VE7,IEAr A*eEM5 m'tNa3pwicmim W,of Whi
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❑ Remove and dispose of# __QN_e� existing entrydoor.unna. P0jr4A'#0* LdAl s0a0, ne6 o,aZr it Y- i;
O. Install dew entry doorsB__ J,�,Q Manuiadfurer._S1A Y7PiS�. T,Jserios
Location 12 A C 4A.i�,m" ka _ f. WA �'_..—_-......�
Type: O steer 4 RIj mgfa9e efsliding Pa110 Ueor O Praneh Hinood pertlo Door
Model X IgL�_.• _ Slddtigbga)N.,. '9Ioaflgh(a)'typahnodel#
npTiQNS: 1 y�u d :�n1�rFQrrc un
O Adjustable thrashofd far tbor, a Wide for Palo doors; Sryle:,_
Prrefinfehed n,yes Cno colors interior____, exterior ---
W/wwm mr shrink the size of the opening 'Derails. Frri•,Ma� �e7 I i_F ��_
❑ Cover exterior(rlrp wiih.alumirwm:coil stock;
War
Hardware; OLoaksat i7 Deadbolt N(/Faottialt O,Mali Slat APeapaiter 09YWf �..�T.
cy r4oplace lnierfor Prim agalillQMW Details_mr, LV�"I/r 'igd;�dr1 �Lt ter,,., .I,,, a
i1 Replace exterior trim asnoeded. Details
install oak strip at floor as needed,
/Cpulk interior and eldWor edges.
'sd/In 'elate around new door unN Wherd poss)ble.
'¢I!�Pe^invag fmawncfuded. Details
a Included in RIs pr6p63al UoWi up and'Osen op,
U ODOR
.J Remove and dispose of# _.....,. existing:storrndoor(s).
O Iriatall new albon doors a _ Manidatujfs
Styta Color 'type: ❑Alumlreun Q Solid Core
O Location:
'J Hardware style _. Color
SREGIA�iNS IJCTiONS:
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Contragor dote: Buyer'sIsitis.1w
f
8DOITIONALTERMS AND CONDITIONS t "
Contractor Responsibility.The ContfaemY oval issuadts formal warranty upon lull Payment,which shall cordtute the: ,
conuactor`s warranty for the labsrand materials provitled lotha Buyer.Contractor agrees that all work done pursuant
to this contract$hall;be 4 a workmanlike manner using profeaeional quality materials and supplies;Warrantieg are.
available.fonlnspgbtion at the time of signing of the WrlI ebb Cohnectoraecepts'ho rasponsibiIl1y,for any damage
resulting from structural or other defects in the propsity at which the Instalistidn is Carded not Buyer acknowledges
Contractors products do,not corrector cumstrucdurai problems;Contractor shall not be responsible for,(a)any
demands arising in whale a in part from strikes,fires,accidents,floods,gbvemmantal actions or any other causes
beyond eonevl,cf Contraptnr or(b),any;damages Including without limitation,lost pro*Or reduction it value of Buyers
properly,arising from Contractor's delay In performing.under this Agreemsnt of due:to Its breadh Of ihfs Agreement,
CondensatlonlMold;The contractor is not maponalble for conditions beyond,its control,such as eondensatlOFl which
may tc7rm on or within a window or hetimen windows resulting from pre-exisfing conditions in the Buyers home and
external temperatures-Soma oondensatlon may also Pone m<the'fmme or potions of the root.Reduabg.,the humidity In
your home will often rsmedy'any cbndahsattbri problems,The Contractor is also naG.msponsible.far oxiating or
developing sport or mold growth.Mold may be due to mndensatlon which may form on or within wal{s or other surfaces
resuhing from(pre-dxistIN oonditatis in Ilse 8401'8 porno and internal or axtpmat temperatures,Buyer indemnifies And holds Contractor and Its orrtplayses,authorized conlractdrs and thou subcpntreCtOrs from any glaims as lo.tha
IdenafrOation,detarxion,abatement,encapsdstldn or rmnwalof mold.asbestos;lead based products or other,hazardous substances Imilda Oroutsids of Ins structure beingimproved,
Permits�.ln Massechueeds,the Gomracror is responsible For applying forand obtalnlnn arty and all necassarp
permitting.Homeowners who secure their own.permits will ba oxeluded from the guaranty fpnq Provisions of
masaachusods law.
DelayfUnldrOwn Conditions:Evenlsteyond,the control of the Contractor,such as Acts of God,labor strikes,
mclamentweattar material sharragea,9uyer`a inability to qualify or obtain finanefng.dolaya ey yocal.gavemmene
authprities trrsevmg or
o{herwiae apprpvirrg tnspac8ons,permitting or other required authodzationa for the jab;or other
events resulgng.fn dew in pgrrOrmanca of this agreement do not constitute abandonment and am Tint included In
calcufstfng time'tram 5 for parfonnanca by Contmcmr,fn the event.the Contractor datennlnas that A'greament cannot h'a perforifymed as intend'eil by the parties.due,for example,to inII]ndbt ptcing;unforeseen structural defects or
pro-exfating cdnditiorta m theBuyers property,the Contractor may pancel this Agreement rythln 30 days.ot its
I a u y r ) Av the Buyer of such a cancaliatich In wrlgng and return all menie3 paid by the Buyer.The Contractor and
the Buy
have detemtlned that adotrdta completion data Is not of the essence to this Agraement,ContrastorwlEl not
be rasponaible for AAy work not sped6cally€fistedfn this Agreemort.or the Addendum,
Late Caneallatiorb latwPaymantlDetauitr If Buyer dttar4tp18 to CanGBi this Agreement a(any trine subsequent midnight of the third business day after the'tlatO Of the Agreement,as more fully daidbad on the NoB a of Rigbt to
Cancal form,and Gontfacfor agcepts such late.cancellation,dten Buyer agrees ro,pay'Cvniractor a'cancelladpn foe equalto.(i)15%.of the,Agreemerd'spurchase price to aFfeot Centradtors incurred labor,8dfiitl{stretiyd feas•and material cysts;plu&{0)the Contrauora poetsPor any speoiallyordersoraoy custdnt manuMdturedltema,:Bayeragrees to pay t,>ir/k Per mentor on.all amvOn%duo and owing front the buyerto the,Cvdfractor as
otWing flom�lhe date due and
rdnrting to thg dple.ihe payment is.made;IF Buyer is lq default of this Agreement,Buyer agrees to pay Po'ntractdr'e
attornay�feee equar to 1S%of ihedafaultad amount or as.otherwise Atlowad by applicable.law.euyeh:alad agrees'ta'.pt(y any other costs or expenses,of'repessoslon,collection,.or realtzanon on anysecunfy intttrtling abort costs,to the
extanfriol prohibited by law,
Secutitylnthrast.'fhis contract may result In a Tian on or lkulilylriletedt on your raeidenye.Buyer giants Conhaclor a
aodudty interest under Itie Uniform Commercial Code end oth®r applicable levi governing security interests in the
ptoperty,purChilSedpursuant to 01is Agreement,Ineludfng 4 sa'curity interest in any proceeds ftom tha sale of such
Property.Buyer agrees that the property purchased under this AgreameoCls,and will.remain,;itersonel property,
regardless of the fact that said personal property may become attached to Buyers foal property:
No Set,Offs qr Retentions.Upon substantial comple8on of the Contractors perfomlanoai Buyer sh611 pay AllAmounts
due undorihis Agresmarrt in accordance with its:tems,wlthoutany right of sel-off orretenhon,'Subsiahhsl completion is.
dafined.as the job being matel)ally cmnpteted,fungtlonal as intended,ands floatinepecilon,'permitbr oixtrdancy cerobate,as the case:may be,haying bgen obtalned.If after msking full payment the.suyet:albgeathat.8iancy fie defective.in any respect,the Contractor'
or,rvl
erfo thehs sxlentthoutxtalBuyerfsvfihg any of ha rights;shatcrim eo inepedton of the premises and
prm anyrsMadial work.to .the entded.lfiereto uryder tt3,Agraemant ortha Cgntmotor'4:rvarranty at60 cost to the Buyer.
Buyer's Rspmeentatlons:Buyer rapremitte and w9Yranf5 That(a)Qrry credit inforrtmtldt.furnlshed by Buyer In
oonneCEidn wnhtlis tfanaaclibn Is five arideolople
the procurete;(b)no person has premised or offered to pay,Credit,or allow to
Boyar any compensation or rewartl for nt or an Agreement with ethers as an inqueementto enter into this Agreement;(a)no person has billeted'
delivered,paid,credited,or allowed to euyerpry gill,bonus,award,money,
merchandise;trading stamps,or cash'loan as an inducement b antedng lido)hia Agreement,,(d)Buyer Is the owner of
the propgny.where the goods and services are.being provided.
Mlgcdllaneous:Pmbtgms and inquirles can be directed to Ina 00nuardaq who may be te4Hred at the telephone
number on the front ofthis Agreement.In Construing this AgMembol,.the gender and number of.words used maybe
changed tome,at the nontW:Any pare of this Agcaoment contrary to law of this State shall not invalldete other pads of
this Agresment,'fhis Agreement.is to be governed by line.lavvs of the'Slate In which it is performed,All oontractore arxt subcontractors must 46 fegislered by the administrefor of flte Massachusetts Board of Budding
flegulatlona and Stsndalds.atd arnringti eb iries dut a Cont Mato
ror auhsgrttradtor relating to a regtatratfon
should be tllrectad to the Olrecto�,Home Improvement Contractor R@91sfrullon One Ashburlod Ptaee RdoM
1301,Boston,MA 02108 Tot:(617)727.8098.This Agreemsbtanil:enysccomparryi Tie Ashbunto rbplaco the
entire agreement between the'parties and there are.no poor or'ccnta:any aneous or-at g V11110dovurmintA r lnanle_or
represesitatibhs'on ovhich either party fs'rtSlyIng,Any marlikationsto this l�reementahall not be effective untass.ln
wndng,signed by the Buyerfs)and a ptG Identer
Vlce Presidont:bf Contrectbr;The aactlon h"dings contained in ti's
Ageeenfont era insetted for
rbnvgniaBce onlyand shall not affaetit,prii Vey tle:mda
Agreement. ning or Ir?tarpfatation.otirya
r
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Control No: 33262
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF LABOR
DIVISION OF OCCUPATIONAL SAFETY
19 STANIFORD.STREET, EomN, MASSACHUSEM 02114
LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER
A & A Services, Inc.
115 North Street
Salem, MA 01970
WAIVER: LW 000318 EXPIRES: February 12,2015
IN ACCORDANCE WITH M.G.L. C. 111, § 197(B)(b)AND 454 CMR 22.03(3)(b),
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS
ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR
ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION
WORK.
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST
BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C.
111, § 19713(b) AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE
RENOVATION WORK.
", '�
HEATHER E, ROWE,ACTING COMMISSIONER
Massachusetts -Department of Pubic Safety r
IV
Board of Building Regulations and Standards -+.
Constructi-n Supervisor o Program
License: CS-057733 UenJ
r.
11 1 Fiber Cement Siding
a
CHRISTOPHER ZORZY
115 NORTH sT _ Chri t8 stopher Zorzy n 201204260040
Salem iNA 01970 �� '. A&A Services Inc Exp 4262017
115 North St t
' s Salem, MA 01970 i
r`"� =XplfatlOn
Commissioner 05/26/2015 Matthew J Gibson
xxyp comet Aoyam .
Administered by Data W orks International,Inc.
Office of ConsumerAffairs&Business Regulation
> _
HOME IMPROVEMENT CONTRACTOR
yam,
Registration: 101609 Type:
^ zpiration: 6/26/2016 Private Corporatic
A&A SERVICES, INC
Christopher Zorzy
115 North Street
Salem, MA 01970
Undersecretary
t The Commonwealth of Massachusetts
a Ik Department of Industrial Accidents
w L t Office oilnvestigations
600 6Vashington Street, 7`l' Floor
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
C
Applicant infor nation: Please PRINT leeibly
name: _ f— :5—h/ �/.k f�122'��2 .
address' L l VO✓ ! G\ l�! i�2Q�" ��t
city 1rnItti-, state: Mrs zip: D/ /p
-7o phone# �97F-711i-ey2V
work site location(full address)' IT
w t It n ui A"LP F �I , k, r ' W 0 ( 9 f7 D
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ZRemodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition
[� I am an employer providing workers' compensation9 for my employees working on this job.
company name: fT 'f'. ?T -�Q�V l (QS F C
address: v
city' 's i—FL-0-
ee t^-, M ( ohone#: r—�I 70/— /rt�7] l �/�
insurance co I —0 -✓ra l✓'Q I "Q r- 15 oul'ev# lJ�l'd � 14�1 ?d 5
❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city phone#:
insurance co. police#
company name:
address:
city: phone#:
insurance co policv#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of vIGL 152 can lead to the imposition ofcriminal penalties of a rate up to SI,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.06 a day against me. 1 understand that it
copy of this statement may be forwarded[o the Bice of Investigations of the DL\for coverage verification.
/do hereby
/cerfifp Zethpains and p unities of perjury that the information provided above is true nnrlrfpcorrect.
Signaturd✓ Date I U' ?O1•� �� /}�
Print name✓I C'{'O�I / 2OYZ�./ Phone# 0 7 7
official use only do not write in this area to be completed by city or town official
city or town: permit/license# []Building Department
[]Licensing Board
❑check if immediate response is required []Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised Sepi.2001)
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� Pe �➢ Aso �di , Zb code
: 30=
www w Phone: 978-741-0424
-2012
I""��iiA `� ` Fax: 9vices. om
JJ J www.a-aservices.com
115 North Street
Salem,MA 01970
October 29, 2014
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit,apprlication for Jillian Brooks, 18 Willow Avenue,
Salem, MA to replace a sliding patioldoor.
I have enclosed a check for$35 based on your fee schedule of$7 per$1,000.00.
The total for the job was $4,610.00.
Please send the completed permit to At A Services, Inc. at 115-North Street,
Salem, MA 01970. `--1 /
If you have anzuestio ns, lease com ct me at 978 741-0424.
P � )G y
Thank you for your assistance.
f 1
Sincerely, n
Barbara Zoizy�
Office Manager